After Flexner, a new start

In 1910, the medical school’s fate hung by a thread. The deep criticisms it weathered in a landmark report ultimately made it a much stronger institution.

By Pem McNerney

The release of the Flexner Report in 1910 was bad news for most of the nation’s medical schools. Commissioned by the Carnegie Foundation for the Advancement of Teaching to evaluate the ability of U.S. medical schools to train new doctors, consultant Abraham Flexner’s verdict was that most weren’t up to the task. He recommended that the vast majority of schools be shut down; in New England, he said, the only two worth saving were Yale and Harvard. And despite the tacit endorsement, the report singled out Yale’s thinly stretched faculty as a weak point. “The instructors ... are overworked, being called on to carry the routine work of extensive subjects in all their parts without adequate assistance. Under such circumstances, the work, however conscientious, is bound to be limited.” The report also recommended that the school obtain a larger permanent endowment.

The School of Medicine’s bleak condition at the turn of the century and its successful efforts to rehabilitate itself are the subject of Medicine at Yale, 1901–1951, the second in a series of exhibits at the Cushing/Whitney Medical Library marking the University’s Tercentennial this year. The exhibit, which has been adapted for the Web, shows how, in the 1920s, the school transformed itself from a mediocre institution with part-time faculty and limited resources into one of the nation’s top medical schools. With a full-time staff, new facilities and many new departments, including the innovative and controversial Institute of Human Relations, the school generated enough momentum in the ’20s to survive both the Depression and World War II intact.

The Flexner Report’s grim assessment of Yale’s resources and facilities came as no great surprise to the school, which had been struggling for its survival since the 1880s. Herbert E. Smith, dean from 1885 to 1910, had made some improvements. He tightened entrance requirements, expanded the curriculum and made efforts to establish closer ties with New Haven Hospital. His successor, George Blumer, dean from 1910 to 1920, was able to establish a sorely needed, more functional system for key faculty, providing them with a full-time salary for teaching and research. He also oversaw the growth of the endowment fund and forged an agreement with New Haven Hospital that allowed the school to take charge of the wards and use them for medical education. One of Blumer’s proudest achievements was the establishment of the Department of Public Health in 1915, with Charles-Edward Amory Winslow as its founding chair.

In 1920, Milton C. Winternitz became dean. He oversaw the construction of the Sterling Hall of Medicine, the expansion of clinical facilities and the establishment of several departments, including the Department of Pediatrics (1921), the Department of Obstetrics and Gynecology (1921) and the Psychiatry Group (1935). During his tenure, the Department of Surgery was moved to a full-time basis and the Yale System of Medical Education was established. Under the Yale System, medical students were treated like graduate students, required course exams were eliminated and electives were encouraged. The Institute of Human Relations, specializing in interdisciplinary research in medicine, law and the social sciences, was created in 1931. According to the exhibit text, “Winternitz evoked strong emotions in his colleagues. To some he was brilliant, bold, and a ‘steam engine in pants,’ and to others he was an insufferable ‘martinet,’ a Napoleon, and an anti-Semite” though he was Jewish himself. In 1935 he was forced to step down from his post as dean, continuing on as chair of pathology until his retirement in 1950.

Yale had three more deans during the first half of the century: Stanhope Bayne-Jones (1935–1940), Francis Gilman Blake (1941–1947) and Cyril Norman Hugh Long (1947–1952). Among other notable accomplishments, they succeeded in getting the medical school on solid financial ground so that it could continue to grow following World War II.